Provider First Line Business Practice Location Address:
2624 E 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-919-8822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2026